利用性腺靜脈延長腎靜脈於右側活體腎臟移植手術
許自翔1、陳正彥2、林釀呈2、龍藉泉2、林登龍1,3,4
1臺北榮民總醫院 泌尿部；2臺北榮民總醫院 外科部移植外科
3國立陽明大學 醫學院 泌尿學科；4書田泌尿科學研究中心
The Frankenstein-like Technique with Gonadal Vein for Renal Vein Elongation in Living Donor Kidney Transplantation
Tzu-Hsiang Hsu1, Cheng-Yen Chen2 , Niang-Cheng Lin2, Che-Chuan Loong2, Alex T.L. Lin1,3,4
1Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
2Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital
3Department of Urology, School of Medicine, and 4Shu-Tien Urological Science Research Center, National Yang-Ming University
Introduction: The right renal vein is relatively short and was more difficult for living donor kidney transplantation. Several methods was proposed for renal vein elongation and the gonadal vein is deal because it is essentially useless for donr and easily accessed during surgery. We provide a noval method called Frankenstein-like technique to renal vein elongation.
Case: This 55-year-old woman, a retired teacher, with history of CKD stage V, gastric ulcer under PPI, gouty arthritis, hypertension and C/S was admitted via OPD for scheduled kidney transplantation. According to her statement, the first gout attack happened in 1999, and recurrent about 1-2 times per year afterwards. Therefore, she had long-term colchicines and NSAID use. CKD was noted in 2014 at AIR OPD(Cr: 1.57 on 2014/07/15), however, CKD progression during the past 3 years despite avoiding NSAID and regular OPD follow-up, and CKD stage V developed (eGFR:6ml/min) on 2017/07/06. She experienced decreased appetite, with BW loss 5kg in 3 months, and mild general malaise. She denied dizziness, pruitis, decreased urine amount or color, legs edema, DOE, orthopnea, fever, recent URI symptoms. Therefore, she was admitted to Nephrology's ward during 2017/07/16-2017/07/27. Serial examination was performed. The PD catheter insertion was tried but in vain due to severe adhesion. After discussion and explanation with her and his family, her husband was willing to donate his kidney to her and they received transplantation evaluation. Under the impression of CKD, stage V with pending ESRD, she underwent preemptive LDKT from his husband on 2017/10/11 uneventfully. His husband’s right gonadal vein was harvested for right renal vein enlongation by CVS specialist at back table. Immunosuppressants were adminsitered after operation as protocol. The graft kidney functioned well with much daily urine output. Creatinine level descended rapidly after transplantation as well. Follow-up Doppler sonogram showed normal examination in graft renal vessels.
Conclusions:
The Frankenstein-like technique for renal vein elongation seemed safe and feasible. The graft kidney displayed function well without complication in this case.